The presence of uterine leiomyomas, benign smooth muscle tumors of the uterus, has long perplexed clinicians and the patients who develop them. Their enigmatic appearance is usually silent, but in some women they can precipitate substantial symptoms that do not consistently respond to medical therapy. Leiomyomas develop almost exclusively in women during their reproductive years and their growth, seems to be influenced by endogenous sex steroids. Our hypothesis is that the addition of exogenous hormones via oral contraceptives will accelerate the growth rate of leiomyomas. This supposition is important because, to date, a key component of various medical treatments for menorrhagia caused by leiomyomas are the use of oral contraceptives. Additionally, Black women, who are believed to produce higher levels of estrogens and progestins during the menstrual cycle, have a greater propensity for developing leiomyomas. The oral contraceptives could, therefore, have an additive affect. Studies to determine the influence of leiomyoma growth by oral contraceptives have been largely speculative, conflicting, and infrequently used a case control study design. Their impact on the growth of leiomyomas in Black women, who have the largest percentage of these symptomatic tumors (3 times greater), has never been investigated. In our two-center, case-control observational study, we will directly monitor the growth of uterine leiomyomas in women using oral contraceptives by using serial ultrasound evaluations (every 6 months for 36 months). In addition, all subjects will have serum and urine assays to establish if Black women produce higher levels of sex steroids. Our deliberate effort to recruit a large number of Black subjects provides an excellent opportunity to corroborate those findings. Women selected for this study will be premenopausal and have reproducible evidence of uterine leiomyomas. The case population (n=240) will consist of women using oral contraceptives and the controls (n=80) will be women who have never used hormonal therapy. The patient base in Meharry's urban center will be an abundant resource for the inclusion of Black case subjects sufficient to detect if there truly is a racial difference in this populations' leiomyoma growth rate. This collaborative effort will be a monumental step in ascertaining if oral contraceptive pills accelerate leiomyoma growth. Additionally, this will become a landmark study evaluating the seemingly exaggerated growth of leiomyomas in Black women and possibly correlating that growth difference with their increases in hormone levels.